Psoriatic arthritis is a strong predictor of sleep interference in patients with psoriasis
ABSTRACT We sought to determine what clinical features of psoriasis predict sleep interference.
Data were obtained from 420 respondents to the 2005 National Psoriasis Foundation telephone and e-mail surveys. Logistic regression was used to determine whether disease severity, body mass index, age of onset, psoriatic arthritis, income, ethnicity, sex, current therapy, and quality-of-life measures predicted reported sleep interference within the last month.
Psoriatic arthritis was the most significant predictor of sleep disturbance (odds ratio = 3.26). Itch, pain of lesions, and impact on emotional well-being were also significant predictors (odds ratio 1.26, 1.22, and 1.18, respectively). Body surface area covered with psoriasis, body mass index, and therapy were not significant predictors of sleep interference.
All data were self-reported and not physician-assessed.
History of psoriatic arthritis, presence of itch and pain of psoriatic lesions, and impact of psoriasis on overall emotional well-being predict sleep interference.
- SourceAvailable from: Byung Soo Kim[Show abstract] [Hide abstract]
ABSTRACT: The scalp is frequently affected in psoriasis patients, and pruritus can adversely affect the quality of life of affected patients. Few studies have assessed pruritus in scalp psoriasis. To determine the correlation among the clinical characteristics of pruritus, psoriasis scalp severity index (PSSI), and intraepidermal nerve fiber (IENF) density in psoriatic scalp lesions. Eighty patients (53 men, 27 women; mean age, 46.4 years; mean PSSI, 19.9) with scalp psoriasis were evaluated by using the PSSI and the Leuven itch scale. Biopsies were obtained from the lesional and nonlesional skin of 19 patients (10 men, 9 women; mean age, 37.8 years; mean PSSI, 25.8). Immunofluorescence staining of protein gene product 9.5 was performed to determine the IENF density. Sixty-four patients (80%) complained of pruritus associated with scalp psoriasis, which negatively affected their quality of life to varying degrees. A moderate positive relation between PSSI score and pruritus intensity was identified (r=0.225 and p=0.044). The IENF density in psoriatic lesions was significantly higher than that in the nonlesional scalp (6.2±1.2 vs. 4.2±1.6, p<0.001). However, the correlations between IENF density and PSSI score, and IENF density and pruritus intensity were insignificant. These results indicate that pruritus prevalence is high in patients with scalp psoriasis, and pruritus considerably influences the patients' daily lives and quality of life. In addition, high IENF density in psoriatic scalp lesions may play a role in the development of pruritus in scalp psoriasis.Annals of Dermatology 12/2014; 26(6):727-732. DOI:10.5021/ad.2014.26.6.727 · 0.95 Impact Factor
Article: Sleep-wake disorders and dermatology[Show abstract] [Hide abstract]
ABSTRACT: Sleep is an active process that occupies about one-third of the lives of humans; however, there are relatively few studies of skin disorders during sleep. Sleep disruption in dermatologic disorders can significantly affect the quality of life and mental health of the patient and in some situations may even lead to exacerbations of the dermatologic condition. Sleep and skin disorders interface at several levels: (1) the role of the skin in normal sleep physiology, such as thermoregulation, core body temperature control, and sleep onset; (2) the effect of endogenous circadian rhythms and peripheral circadian "oscillators" on cutaneous symptoms, such as the natural trough in cortisol levels during the evening in patients with inflammatory dermatoses, which most likely results in increased pruritus during the evening and night; (3) the effect of symptoms such as pruritus, hyperhidrosis, and problems with thermoregulation, on sleep and sleep-related quality of life of the patients and their families; (4) the possible effect of primary sleep disorders, such as insomnia, sleep apnea, sleep deprivation, and circadian rhythm disorders, on dermatologic disorders; for example, central nervous system arousals from sleep in sleep apnea can result in increased sympathetic neural activity and increased inflammation; and (5) comorbidity of some dermatologic disorders with stress and psychiatric disorders, for example, major depressive disorder and attention deficit hyperactivity disorder (ADHD) that are also associated with sleep-related complaints. Sleep loss in atopic dermatitis (AD) is likely involved in the pathogenesis of ADHD-like symptoms in AD. Scratching during sleep, which may be proportional to the overall level of sympathetic nervous activity during the respective stages of sleep, usually occurs most frequently during non-rapid eye movement (NREM) stages 1 and 2 (vs stages 3 and 4 which are the deeper stages of sleep), and in rapid eye movement (REM) sleep, where the severity of scratching is similar to stage 2 sleep. Patient and parental reports of nocturnal itch and scratching in AD typically do not correlate with objective measures of scratching.Clinics in dermatology 01/2013; 31(1):118-26. DOI:10.1016/j.clindermatol.2011.11.016 · 1.93 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Poor sleep quality adversely affects quality of life in patients with psoriasis. However, the factors impairing sleep in these patients have not been well described. We reviewed the available literature linking sleep quality and psoriasis to elucidate factors that interfere with sleep. Pruritus, depression, pain, and obstructive sleep apnea may be likely sources of sleep impairment in patients with psoriasis. Fatigue resulting from sleep interference may also be implicated in this relationship. Pruritus, depression, and pain interfere with sleep quality by increasing nocturnal awakenings and sleep fragmentation. Obstructive sleep apnea may occur in a greater percentage of patients with psoriasis than control populations. Factors associated with psoriasis appear to have similarities in their cytokine and neuropeptide profiles. Moreover, these variables are complex and interconnected. Further study and awareness of potential factors impacting sleep in patients with psoriasis may provide new avenues for treatment of recalcitrant disease.Journal of the American Academy of Dermatology 11/2009; 63(1):114-23. DOI:10.1016/j.jaad.2009.07.003 · 5.00 Impact Factor